Abstract

Objective:

Early detection, categorization and management of CV risk patients were proved prospectively to reduce costs. A wide amount of information taken from retrospective files, properly handle, may allow evidence on real world patients.

Objective:

To assess the clinical effectiveness and economic impact of the implementation of a disease management program in a health organization in Argentina using retrospective data.

Design and Method:

Data from 6893 CV screenings (2010–2015) were used. Patients were categorized based on Framingham Score (FS), moderate and high risk then were recategorized using a post-test based on total carotid plaque area; next patients opted for a high risk intensive (HRI) caregiver or an external physicians under pay-for-performance (P4P). Rate of cardiovascular events (CVE) and all direct costs were measured to assess the program's global impact. Next, we define the intervention (HRI) and control groups (P4P) using propensity score matching techniques to obtain pre-treatment comparable populations matched by age, sex, # previous events and FS risk: the events rate, costs and estimated events survival curve was done using survival model.

Results:

The rate of CVE decreased from 137 (1.89 rate/100patients) to 68 events in 2015 (0.98/100 PAR, −53%): the reduction was greater in >65 y.o. The number of patients with >1 event decreased, as well as the proportion of severe events (22,3% to 16,2%). After matching, no difference in the likelihood to CVE between HRI (316 pts / 12,7% event rate) and P4P (306 / 10,8%) groups: nevertheless, we find a slightly reduction in time to event (median HRI 1156 vs P4P 1000 days) and hospitalization time (HRI 3.61 vs P4P 3.25 days/bed). There were no differences between groups on costs.

Conclusions:

Programs oriented to detect early CV risk patients and refer properly to HRI can reduce global events rate in a short time of follow up without increase in costs.